How many foodborne outbreaks of Salmonella infection occurred in France in 1995? Application of the capture-recapture method to three surveillance systems.

Despite control measures, foodborne outbreaks of non-typhi Salmonella infection continue to occur in developed countries. The authors aimed to assess the number of foodborne Salmonella outbreaks that occurred in France in 1995 using a capture-recapture approach. Data from three sources--the National Public Health Network (NPHN), the Ministry of Agriculture (MA), which receives mandatory notification, and the National Salmonella and Shigella Reference Center (NRC)-were collected. Matching algorithms permitted identification of matched outbreaks. The total number of outbreaks was estimated by log-linear modeling taking into account source dependencies and the variable catchability. The final estimate was adjusted for the positive predictive value (66%) of the NRC case definition. The dependence between the NPHN and the MA was also evaluated by means of a qualitative survey. A total of 716 foodborne Salmonella outbreaks were reported to the three sources, and 108 matches were identified. The best-fitting model, taking into account a positive dependence between the NPHN and MA sources, gave an estimate of 757 outbreaks. The sensitivity was 15% for the NPHN, 10% for the MA, and 50% for the NRC. In France, routine mandatory reporting of foodborne Salmonella outbreaks is very incomplete, and it is not representative of the serotype and the type of outbreak.